The Australian Democrats said today they opposed any Government plans for Medicare that would create a two-tier health system.

Democrats’ Health spokesperson, Senator Lyn Allison, said the Government appeared set on creating a system under which concession card holders would be bulk billed, while everyone else would be subject to co-payments.

"It seems the aim of this Government is to suggest to GPs that concession card holders should be bulk billed and that it doesn't matter for the rest of us," Senator Allison said.

“The health system will only be equitable and strong as long as patients are not fragmented into income groups.”

Senator Allison said the Government’s proposal appeared targeted at getting patients paying for their own health care - as in the 1960’s in the era before Medicare or Medibank .

“That relied on an economy of full and stable employment and a bowing down to a system of ‘doctors’ choice’,” Senator Allison said.

“If the Government wants to control health prices, they have to have a stake in the level of fees - just like they do in private health insurance. If anything, the Democrats want the Government to have a percentage stake in the doctors fees - if not 100 per cent, then very close to it.”

Senator Allison said the big danger in this proposal was the removal of the incentive for GPs to universally bulk bill. The plan would make it as easy administratively for doctors to hook into the new system where they could charge a ‘gap’ fee at whatever level they wanted.

“This will definitely see the end of bulk-billing acting to pressure doctors to keep fees down,” Senator Allison said.

“This proposal, as it stands, fundamentally changes the Medicare rebate. Medicare becomes an arrangement between doctors and the Government, with the consumer picking up the tab for the difference.

“By introducing a streamlined process with patients paying extra, the Government subsidy becomes invisible and can be eroded by stealth. It shifts the burden for payment to the individual.”